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Sheff 91 core clinical problems > 59 - Abdominal distention, 60 abdo mass > Flashcards

59 - Abdominal distention, 60 abdo mass Flashcards

1
Q

Causes of abdo distention

A

Fs

Fat
Flatus
Foetus
Faeces
Fluid
Fibroids
Fatal (tumours)
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2
Q

What are ascites? Cause?

A

Fluid accumulation in peritoneal cavity.

liver cirrhosis, metastates, heart failure, TB, Meig’s,

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3
Q

Ix of ascities?

A

USS
FBC
LFTs
ascitic tap

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4
Q

Mx of ascites?

A

manage cause
diuretics
paracentesis - but risk of infection

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5
Q

What is meigs ?

A

Triad
benign ovarian tumor ascites
pleural effusion that resolves after resection of the tumor.

Usually Ovarian fibromas

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6
Q

Sx / signs of hepatomegaly

A

Can feel it

May also cause jaundice, bruising, lethargy, weight loss, poor appetite

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7
Q

Causes of hepatomegaly

A

Infection: mono, hepatitis, abscess, malaria, amoboeasis,

Biliary: PBC, PSC
(Primary sclerosing cholangitis
Primary biliary cholangitis)

Metabolic: haemochromatosis, Wilson’s, glycogen storage diseases

Congenital: haemolytic anemia, sick cell

Neoplastic

Other: alcoholism, sarcoid, drugs,

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8
Q

Causes of splenomegaly

A

haemolytic anaemia, leukemia, lymphomas, portal hypertension, haemoglobinopathies, AIDS, infections,.

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9
Q

Mx if hyperspenic

A

splenectomy

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10
Q

Causes of bowel obstruction

A

mechanical obstruction, adhesions (from previous surgery), hernias, volvulus, tumours, endometriosis, IBD, ischaemic bowel

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11
Q

Sx / signs of bowel obsturction

A

Abdominal pain, vomiting, bloating, tinkly bowel sounds.

First sign is lack of flatus, then lack of stool.

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12
Q

How does bowel obstruction progress

A

toxic megacolon or faecal vomiting.

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13
Q

Ix / Mx of obstruction

A

Give iv fluids and pain medication.

USS, CXR and CT.

Needs urgent surgery.

DO NOT give laxatives.

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14
Q

Causes of volvulus

A

Malrotattion, Hirschsprung, pregnancy, adhesions,

Obvs needs urgent surgery

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15
Q

PKD can be AD / AR. Signs?

A

Mass

hypertension, headaches, abdominal pain, haematuria, polyuria leading to renal failure.

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16
Q

Gene in PKD

A

PKD1-3 leads to faulty polycystin-1 and 2 which leads to cillial defects.

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17
Q

Severe PKD mx

A

dialysis / transplant

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18
Q

Bowel mass DDx …name 4

A

obstruction, intussusception, volvulus, pyloric stensosis, cholecystitis, hernias, hepatomegaly, tumour, aneurysm, abcesses, diverticulitis, IBD,

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19
Q

What is pyloric stenosis? usual age?

A

Narrowing of the connection between the stomach and the duodenum (pylorus)

Usually occurs in the first few months of life. Occurs more in boys.

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20
Q

Signs of pyloric stenosis

A

Projectile non-bilious vomiting.

olive shaped mass in epigastrium.

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21
Q

Seen on Ix of pyloric stenosis

A

Capillary blood gas shows a metabolic (hypochloraemic, hypokalaemic) alkalosis due to repeated vomiting. This is diagnostic.

Surgeons usually want an ultrasound.

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22
Q

Mx pyloric stenosis

A

pyloromyotomy

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23
Q

What is cholecystitis ?

Sx ?

A

Gallbladder inflammation.

Right upper abdominal pain, nausea, vomiting, fever,

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24
Q

Usual cause of cholecystitis

A

bile duct blockage

can be vasculitic

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25
Q

Complication of cholecytitis

A

gallbladder rupture -> empyema

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26
Q

Mx of cholecystitis

A

cholecytectomy
pain control
Stones can be removed by ERCP

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27
Q

what is ERCP

A

Endoscopic retrograde cholangiopancreatography

endoscope into bile duct

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28
Q

Gallstones called? Usual Mx

A

Cholelithiasis.

Most are silent and do not require treatment.

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29
Q

Sx of symptomatic gallstones

A

Cramping colicky pain in the upper right abdomen. Hepatomegaly, fever, jaundice, dark urine and vomiting

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30
Q

Rfs for gallstones

A

fat, fair, forty, pregnant, family history, diabetes, liver disease

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31
Q

What are gallstones made from ?

A

cholesterol / bilirubin

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32
Q

What is the stupid law of courvoisier?

A

painless jaundice and enlarged gallbladder, the cause is unlikely to be gallstones.

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33
Q

Mx of gallstones

A

Shock wave lithotripsy

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34
Q

Usual Ca in pancreas ?

Sx? prognosis?

A

Usually adenocarcinoma.

Disease usually silent. Jaundice, weight loss, back pain, loss of appetite. May secrete

Poor prognosis due to the fact that even non-specific signs indicate advanced disease.

35
Q

What do people with pancreatic cancer tend to get? mets go where?

A

DVTs

liver

36
Q

What is urinary retention

A

Inability to completely empty the bladder. Can become incredibly painful.

37
Q

Causes of urinary retention

A

BPH, neuropathy, constipation, infection, drugs, tumour, iatrogenic, prostatitis, phimosis

38
Q

Complications of urinary retention?

A

Stones, infection, rupture

39
Q

Dx of urinary retention

A

bladder US

40
Q

Mx if prostatic cause of urinary retention

A

foley catheter / prostatic stent

41
Q

Bladder ca which cells?

A

urothelium (transitional cell)

42
Q

Rfs of bladder ca

A

rubber and polycyclic aromatic hydrocarbons, smoking, genetics, schistosomiasis,

43
Q

Signs of bladder ca

A

Haematuria (may be microscopic), dysuria, polyuria, urge,

44
Q

When does bladder ca have a poor prognosis

A

when muscle wall is invaded

45
Q

Ix / Mx bladder ca

A

Cystoscopy and biopsy
US / CT / MRI

Treat with resection surgery, BCG immunotherapy, chemotherapy

46
Q

What is diverticulitis?

A

Arising from diverticulosis: outpouching of large bowel wall

->infection

47
Q

Sx diverticulitis

A

Sudden onset lower abdominal pain, fever, nausea, vomiting, constipation, blood in the stool.

48
Q

rfs diverticulitis

A

smoking, diabetes, NSAIDs, low dietary fibre

49
Q

DDx diverticulitis

A

IBS, IBD, malignancy,

50
Q

Complications of diverticulitis

A

Sepsis

bleeds, abscess, perforation, adhesions, fistulas and faecal impaction.

51
Q

2 key Ix in diverticulitis

A

CT and colonscopy.

52
Q

Mx of most diverticulitis

A

conservative

53
Q

Skip leisions found in which IBD

A

crohns

54
Q

sx of crohns

A

Abdo pain, loose bloody stools (nature of which decided by section of bowel involved), fever, weight loss.
Anaemia, rash, fatigue, aphthous ulcers, sausage like abdominal mass.

55
Q

Associations with crohns

A

primary sclerosing choelycistitis

enteropathic arthiritis

56
Q

Mx of crohns

A

Oral pred + methotrexate to maintain remission.

Good evidence for Abx.

Surgical resection rarely works.

57
Q

2 main complications of crohns

A

bowel ca

abscesses

58
Q

Sx of UC

A

Abdo pain, loose bloody stools, weight loss, anaemia,

59
Q

Major complications of UC

A

High risk
bowel ca
megacolon
enteopathic arthritis

60
Q

Key Ix in IBD

A

Colonoscopy and biopsy

61
Q

Mx of UC

A

Mesalazine. Prednisolone.

Resection may be necessary.

62
Q

Crohns vs UC

A 
Crohn’s disease
Porridge steatorrhea
Weight loss, fistulae, fever
Skip lesions (‘cobblestone’)
Worsened by smoking
Full thickness inflammation
Granulomas
Crypt lesions
UC
Mucus-like with blood
Tenesmus
Continuous inflammation
Improved by smoking
Peripheral layer involvement
No granulomas on histology
No crypt lesions
63
Q

Complications of ovarian cysts

A

May produce torsion if they twist. Bloating, lower abdo pain.

Can rupture also: vomiting and pain.

64
Q

Sx of PCOS

A

Ammenorrhea, heavy periods, obesity, hirsuitism, acne, pain, infertility.

65
Q

Dx of PCOS

A

Must have two out of 3: high androgens, anovulation, cysts on ultrasound.

66
Q

Rfs of PCOS

A

obesity, lack of exercise, family history,

67
Q

PCOS associations

A

T2DM, obesity, OSA, heart disease, endometrial cancer.

68
Q

How to help fertility issues in PCOS

A

lose weight

metformin and clomifene

69
Q

When does ovarian Ca usually happen? Sx?

A

post-menopause.

Symptoms are non-specific: bloating, pelvic pain.

70
Q

2 key Ix for ovarian Ca

A

CA-125

US

71
Q

What are fibroids? Sx?

A

Leiomyoma: benign smooth muscle tumours. Rarely malignant.

Painful heavy periods, but can be silent.
Dyspareunia.
Can push on bladder: urinary frequency and pain.
Bloating and discomfort.

72
Q

Rfs for fibroids

A 
obesity 
FHx 
PCOS
HTN 
nulliparity
73
Q

Mx fibroids

A

Mild pain relief in mild disease.

Iron supplements may be needed.

Intrauterine system shrinks and manages small disease.

Hysterectomy in severe disease.

74
Q

When do fibroids often naturally regress

A

menopause

75
Q

Complications of fibroids

A

torsion
compress other things
miscarriage

76
Q

What is endometriosis? key sx ?

A

Endometrial tissue present outside of the uterus (ovaries, tubes, bladder, peritoneum, lung).

Dyspareunia, infertility, cyclical pain

77
Q

Complications of endometriosis

A

lowered fertility
adhesions
ca

78
Q

What must you consider in any woman of reproductive age with abdo pain ?

A

ectopic

79
Q

Rfs for ectopic

A

IUD and coil increase incidence. PID, chlamydia, smoking, infertility treatment, previous ectopic,

80
Q

Major complication of ectopic

A

rupture

81
Q

Dx of ectopic

A

HCG urine dip and ultrasound.

82
Q

Mx ectopic

A

methotrexate

surgery

83
Q

Rfs for hernias

A

Post-op, congenital, coughing, straining, weight lifting, pregnancy, connective tissue disease are all risks.

Sheff 91 core clinical problems (51 decks)

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